Objective
Tailored digital health programs can promote positive health-related lifestyle changes and have been shown to be (cost) effective in trials. However, such programs are used suboptimally. ...New approaches are needed to optimise the use of these programs. This paper illustrates the potential of recommender systems to support and enhance computer-tailored digital health interventions. The aim is threefold, to explore: (1) how recommender systems provide health recommendations, (2) to what extent recommender systems incorporate theoretical models and (3) how the use of recommender systems may enhance the usage of computer-tailored interventions.
Methods
A scoping review was conducted, using MEDLINE and ScienceDirect, to identify health recommender systems reported in studies between January 2007 and December 2017. Information was subsequently extracted to understand the potential benefits of recommender systems for computer-tailored digital health programs. Titles and abstracts of 1184 studies were screened for the full-text screening, in which two reviewers independently selected articles and systematically extracted data using a predefined extraction form.
Results
A total of 26 articles were included for data extraction. General characteristics were reported, with eight studies reporting hybrid filtering. A description of how each recommender system provides a recommendation is described; the majority of recommender systems used messages as recommendation. We identified the potential effects of recommender systems on efficiency, effectiveness, trustworthiness and enjoyment of the digital health program.
Conclusions
Incorporating a collaborative method with demographic filtering as a second step to knowledge-based filtering could potentially add value to traditional tailoring with regard to enhancing the user experience. This study illustrates how recommender systems, especially hybrid programs, may have the potential to bring tailored digital health forward.
Background
Adequate sun safety during childhood is crucial for decreasing skin cancer risk in later life. Although parents are an essential target group in applying sun protection measures for their ...children, insight into the determinants associated with their sun protection behaviors is limited.
Aims
This study aims to identify the most relevant determinants in predicting multiple parental sun protection intentions and behaviors in different sun exposure situations.
Method
A longitudinal survey study with two measurements was conducted among Dutch parents (N = 670) of children (4–12 years old). Twenty-seven sociocognitive determinants were examined in terms of relevance regarding four parental sun protection behaviors in different sun exposure situations. The Confidence Interval-Based Estimation of Relevance approach was used to visualize room for improvement (sample means) on all determinants and their association strengths (correlations) with sun protection intentions and behaviors.
Results
Behavior-specific rather than generic determinants were most relevant in explaining all sun protection behaviors. Of these determinants, attitude, self-efficacy and action planning, and especially parental feelings of difficulty in performing sun protection behaviors, were most relevant. Altogether, the explained variance of all sociocognitive determinants was highest for shade-seeking behavior (R2 = .41 and .43) and lowest for supportive behavior (R2 = .19 and .29) in both planned and incidental sun exposure situations, respectively.
Discussion
This study provides detailed insight into relevant sociocognitive determinants of parental sun protection behaviors in various sun exposure situations and directions for composing parental skin cancer prevention interventions.
Conclusions
Future composition of sun safety interventions should emphasize on enhancing parental feelings of self-efficacy, especially for shade-seeking and clothing behaviors.
There is very little evidence whether recalling and answering questions about abuse or interpersonal violence has a positive or negative impact on participants of such research. This is an important ...ethical dilemma to ensure an appropriate risk-benefit ratio in research with young people is maintained. We assessed reported harms, benefits, and regrets of young adolescents who participated in a sensitive research project, and compared the harms and benefits in those who had and had not been victims and/or perpetrators of abuse or intimate partner violence. Participants were 3,264 adolescents aged 12 to 15 years in 41 public schools in the Western Cape, South Africa, who completed a survey about intimate partner violence, verbal, physical, and sexual abuse, as part of an HIV prevention cluster randomized controlled trial. The majority of participants reported research participation as beneficial (70.3%), while 27.7% reported harms and 14% regrets. Victims of abuse were more likely than non-victims to report benefits (71.9% vs. 67.1%; p = .02) and harms (31% vs. 20.9%; p < .01) and were less likely to report regret (13.1% vs. 16.7%; p = .02). Perpetrators of abuse were less likely than non-perpetrators to report benefits (67.4% vs. 72.8%; p = .01) and more likely to report harms (36.4% vs. 26.1%; p < .01) and regrets (17.4% vs. 13.3%; p = .01). Our findings suggested that research participation was more likely to have a positive rather than a negative emotional impact on young adolescents and that relatively few regretted participating. Victims and perpetrators of abuse were more likely to report benefits than harms, supporting the ethical appropriateness of ongoing research on abuse and violence. We recommend that further research is required to clarify and standardize terminology and instruments to quantify these kinds of evaluations, including measurement of the severity and intensity of reported benefits, harms and regrets, and the longer term impact of participation in sensitive research.
In public health monitoring of young people it is critical to understand the effects of selective non-response, in particular when a controversial topic is involved like substance abuse or sexual ...behaviour. Research that is dependent upon voluntary subject participation is particularly vulnerable to sampling bias. As respondents whose participation is hardest to elicit on a voluntary basis are also more likely to report risk behaviour, this potentially leads to underestimation of risk factor prevalence. Inviting adolescents to participate in a home-sent postal survey is a typical voluntary recruitment strategy with high non-response, as opposed to mandatory participation during school time. This study examines the extent to which prevalence estimates of adolescent health-related characteristics are biased due to different sampling methods, and whether this also biases within-subject analyses.
Cross-sectional datasets collected in 2011 in Twente and IJsselland, two similar and adjacent regions in the Netherlands, were used. In total, 9360 youngsters in a mandatory sample (Twente) and 1952 youngsters in a voluntary sample (IJsselland) participated in the study. To test whether the samples differed on health-related variables, we conducted both univariate and multivariable logistic regression analyses controlling for any demographic difference between the samples. Additional multivariable logistic regressions were conducted to examine moderating effects of sampling method on associations between health-related variables.
As expected, females, older individuals, as well as individuals with higher education levels, were over-represented in the voluntary sample, compared to the mandatory sample. Respondents in the voluntary sample tended to smoke less, consume less alcohol (ever, lifetime, and past four weeks), have better mental health, have better subjective health status, have more positive school experiences and have less sexual intercourse than respondents in the mandatory sample. No moderating effects were found for sampling method on associations between variables.
This is one of first studies to provide strong evidence that voluntary recruitment may lead to a strong non-response bias in health-related prevalence estimates in adolescents, as compared to mandatory recruitment. The resulting underestimation in prevalence of health behaviours and well-being measures appeared large, up to a four-fold lower proportion for self-reported alcohol consumption. Correlations between variables, though, appeared to be insensitive to sampling bias.
COVID-19 vaccine hesitancy may be regarded as a new pandemic hindering the elimination of or coping with COVID-19. This study assessed reasons for COVID-19 vaccine hesitancy using the I-Change Model ...(ICM) by considering the role of informational and psychosocial factors. A cross-sectional online survey using a convenience sample was conducted among Dutch adults (
= 240). The questionnaire assessed information factors, predisposing factors, awareness factors, motivational factors, preparatory actions, and vaccination intention. Vaccine hesitant participants (
= 58, 24%) had lower levels of education, more often paid work, and tended to have a religion other than Catholicism. They used written media less often and tended to visit websites of public health organizations less often, but used messaging services like WhatsApp more frequently. All participants had neutral intentions towards checking information credibility. Vaccine hesitant respondents had less knowledge about vaccination, lower perceived severity of getting sick and dying of COVID-19, and reported fewer exposures to cues about the advantages of COVID-19 vaccination. They were less convinced of the emotional and rational advantages of COVID-19 vaccination and expressed more negative feelings about it. They also reported more negative social norms concerning COVID-19 vaccination, and lower self-efficacy to get vaccinated and to cope with potential side-effects. The regression model explained 58% of the variance in vaccination intention. The results suggest that strategies are needed to: 1. Reduce fake news and stimulate information checking to foster well-informed decision-making; 2. Target both rational and emotional consequences of COVID-19, in addition to strategies for optimizing levels of knowledge. Campaigns should acknowledge the perceptions of the emotional disadvantages and increase perceptions of emotional advantages of COVID-19 vaccinations, such as reducing feelings of regret, and increasing feelings of freedom and reassurance.
Communication between parents and their adolescent children has been identified as one of the potential protective factors for adolescent sexual health. Qualitative exploration of sexual health ...communication with adolescents aged 12–15 (N = 114) and a sub-group of the parents (N = 20) was carried out. Four major themes emerged: reasons for parent–adolescent communications, or lack thereof; the focus of parental messages; the moral of the message; and the barriers to communication between parents and adolescents. Findings revealed similarities and discrepancies in views and perceptions between parents and adolescents. Adolescents and parents suggested that some sexual health communication was happening. Parents were reportedly likely to use fear to ensure that their children do not engage in risky sexual activities, while adolescents reported that conversations with their parents were mostly ambiguous and filled with warnings about the dangers of HIV/AIDS. Several communication barriers were reported by parents and adolescents. Parents of adolescents would benefit from HIV/AIDS specific communication skills.
We aimed to examine the behavioural and clinical risk factors for non-communicable diseases (NCDs) at baseline and their changes over 12 months in a workplace cohort in Singapore. A total of 464 ...full-time employees (age ≥ 21 years) were recruited from a variety of occupational settings, including offices, control rooms, and workshops. Of these, 424 (91.4%) were followed-up at three months and 334 (72.0%) were followed up at 12 months. Standardized questionnaires were used to collect data on health behaviours and clinical measurements were performed by trained staff using standard instruments and protocols. Age-adjusted changes in risk factors over time were examined using generalized estimating equations or linear mixed-effects models where appropriate. The mean age of the participants at baseline was 39.0 (SD: 11.4) years and 79.5% were men. Nearly a quarter (24.4%) were current smokers, slightly more than half (53.5%) were alcohol drinkers, two-thirds (66%) were consuming <5 servings of fruit and vegetables per day, and 23.1% were physically inactive. More than two-thirds (67%) were overweight or obese and 34.5% had central obesity. The mean follow-up was 8.6 months. After adjusting for age, over 12 months, there was a significant increase in the proportion consuming <5 servings of fruit and vegetables per day by 33% (
= 0.030), who were physically inactive by 64% (
< 0.001), and of overweight or obese people by 15% (
= 0.018). The burden of several key NCD risk factors at baseline was high and some worsened within a short period of time in this working population. There is a need for more targeted strategies for behaviour change towards a healthy lifestyle as part of the ongoing health and wellness programs at workplaces in Singapore.
Addiction problems impact not only the persons with these problems but also family members. This study aims to examine the impact of the COVID‐19 pandemic on stress, strain on health, study ...experiences, coping strategies, and access to support of students with relatives with addiction problems. Thirty students, aged 18–30 years, from a University of Applied Sciences in the Netherlands participated in a three‐year qualitative longitudinal interview study. One round of individual semi‐structured interviews was conducted before the COVID‐19 pandemic, and three during the COVID‐19 pandemic. Directed Content Analysis was applied, using the Stress‐Strain‐Information‐Coping‐Support‐model. Four major themes were identified: (1) Increase in stress and strain; (2) Decrease in stress and strain; (3) Coping strategies, and (4) Access to social, professional, and educational support. Before the pandemic, most participants had health problems, especially mental health problems, including problems with their own substance use. Some had study delay. Analysis revealed that during the pandemic, most participants experienced an increase in these problems. This appeared to be related to their living situation: An increase in violence and relapse of relatives increased stress, especially for those living with their relatives. The coping strategies ‘standing up’ or ‘putting up’, and a decrease in support—social, professional, and educational—also contributed to stress. A few participants experienced less health problems and study problems. This was related to diminishing addiction problems of relatives, less social pressure, available help, and the coping strategy ‘withdrawing’. Withdrawing was much easier for participants who did not live with their relatives with addiction problems. It is recommended to keep schools and universities open during pandemics, offering a safe haven for students at risk in the home situation.
Worldwide, adherence to national guidelines for physical activity (PA), and fruit and vegetable consumption is recommended to promote health and reduce the risk for (chronic) disease. This study ...reports on the effectiveness of various social-cognitive interventions to improve adherence to guidelines and the revealed adherence predictors. Participants (
n
= 1,629), aged 45–70 years, randomly selected and recruited in 2005–2006 from 23 Dutch general practices, were randomized (centralized stratified allocation) to four groups to receive a 12-month lifestyle intervention targeting guideline adherence for PA and fruit and vegetable consumption. Study groups received either four computer-tailored print communication (TPC) letters (
n
= 405), four telephone motivational interviewing (TMI) sessions (
n
= 407), a combined intervention (two TPC letters and two TMI sessions,
n
= 408), or no intervention (control group,
n
= 409). After the baseline assessment, all parties were aware of the treatment groups. Outcomes were measured with self-report postal questionnaires at baseline, 25, 47 and 73 weeks. For PA, all three interventions were associated with better guideline adherence than no intervention. Odds ratios for TPC, TMI and the combined intervention were 1.82 (95% CI 1.31; 2.54), 1.57 (95% CI 1.13; 2.18), and 2.08 (95% CI 1.50; 2.88), respectively. No pedometer effects were found. For fruit and vegetable consumption, TPC seemed superior to those in the other groups. Odd ratio for fruit and vegetable consumption were 1.78 (95% CI 1.32; 2.41) and 1.73 (95% CI 1.28; 2.33), respectively. For each behaviour, adherence was predicted by self-efficacy expectations, habit strength and stages of change, whereas sex, awareness and the number of action plans predicted guideline adherence for fruit and vegetable intake. The season predicted the guideline adherence for PA and fruit consumption. The odds ratios revealed were equivalent to modest effects sizes, although they were larger than those reported in systematic reviews. This study indicated that less resource intensive interventions might have the potential for a large public health impact when widely implemented. The strengths of this study were the participation of lower educated adults and evaluation of maintenance effects. (Trial NL1035, 2007-09-06).
Introduction
Alcohol screening, brief advice and referral to treatment (SBIRT) in primary health care is an effective strategy to decrease alcohol consumption at population level. However, there is ...relatively scarce evidence regarding its economic returns in non‐high‐income countries. The current paper aims to estimate the return‐on‐investment of implementing a SBIRT program in Mexican primary health‐care settings.
Methods
Empirical data was collected in a quasi‐experimental study, from 17 primary health‐care centres in Mexico City regarding alcohol screening delivered by 145 health‐care providers. This data was combined with data from a simulation study for a period of 10 years (2008 to 2017). Economic investments were calculated from a public sector health‐care perspective as clinical consultation costs (salary and material costs) and program costs (set‐up, adaptation, implementation strategies). Economic return was calculated as monetary gains in the public sector health‐care, estimated via simulated reductions in alcohol consumption, dependent on population coverage of alcohol interventions delivered to primary health‐care patients.
Results
Results showed that scaling up a SBIRT program in Mexico over a 10‐year period would lead to positive return‐on‐investment values ranging between 21% in scenario 4 (confidence interval −8.6%, 79.5%) and 110% in scenario 5 (confidence interval 51.5%, 239.8%). Moreover, over the 10‐year period, up to 16,000 alcohol‐related deaths could be avoided as a result of implementing the program.
Discussion and Conclusions
SBIRT implemented at national level in Mexico may lead to substantial financial gains from a public sector health‐care perspective.
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